Download Free Dual Eligibles Book in PDF and EPUB Free Download. You can read online Dual Eligibles and write the review.

States have been seeking federal waivers since the early 1990s to use managed care approaches to integrate the delivery of acute & long-term-care services for certain dual eligiblesÓ -- low-income Medicare beneficiaries who also quality for full Medicaid benefits. Dual eligibles often receive their Medicare & Medicaid benefits from two different sets of providers. This report determines: (1) the status & key features of state initiatives to integrate care for dual-eligible beneficiaries; & (2) factors that have contributed to the length of the waiver negotiation process & implementation time frames.
The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.

Dual Eligibles

United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health

Published: 2012

Total Pages: 340


Get eBook

A physician usually manages a healthcare organisation and is responsible for a patient's primary needs especially medical care such as physical therapy or surgery. This book provides information concerning patients' well-beings as well as the effects of health care costs and how they reflect on the quality of care of healthcare facilities.
Identifying ways to link Medicare and Medicaid data is a critical step toward integrating care for dual eligibles. Without access to Medicare data, state Medicaid agencies have only a limited picture of the dual eligible population. The availability of linked Medicare and Medicaid data can help highlight areas where integration can make a difference, such as identifying ways to reduce service fragmentation and avoidable utilization. Uncovering these opportunities can help build the case to state and federal policymakers for encouraging enrollment of additional dual eligibles into integrated care programs. This technical assistance brief provides practical information about the types of Medicare data available, how to access these data, and how to use the data to better understand the dual eligible population and uncover opportunities to improve care. The brief: * Outlines Medicare data available through the Centers for Medicare & Medicaid Services (CMS) and the Research Data Assistance Center (ResDAC); * Explains the process for obtaining Medicare data from ResDAC; * Describes the CMS Coordination of Benefits Agreement (COBA) and how it can be used to obtain Medicare claims data; * Provides an overview of how Medicare and Medicaid data can be linked; and * Examines the value of integrated data to support improvements in care for duals.
While the "duals" represent only 16 percent of the total Medicare population and 18 percent of the total Medicaid popula- tion, they account for almost 25 percent of total Medicare spending and 46 percent of total Medicaid spending.1 The health care status of the dually eligible population is quite diverse; many of these indi- viduals have substantial and costly medical and long-term service and s. [...] The variation in duals' health status can present challenges to providers and poli- cymakers trying to meet their needs and contain costs in both the Medicare and Medicaid programs. [...] Approximately 80 percent of the population qualifies for full Medicaid benefits, including long-term services and supports, and are often referred to as "full duals." The rest of the du- als have slightly higher incomes and qualify only for Medicaid assis- tance with Medicare premiums and cost-sharing. [...] There are duals receiving just Medicaid assistance for Medi- care premiums and cost-sharing, and there are duals receiving the full gamut of acute and long-term care services the two programs have to offer. [...] The benefits and challenges of coordinating care across Medicare and Medicaid providers, including how different program and provider incentives can affect duals' care and costs, will be dis- cussed.